7 Series (Radiology)

X-ray

Coding points

 Look for location (e.g) elbow, knee

 Look views (e.g) AP, PA, lateral, oblique

PA-> X-ray beam enters back side of the body and exit front side of the body

AP-> X-ray beam entering front side of the body and exit back side of the body

Oblique-> X-ray beam enters at an angle that is neither frontal nor lateral

Lateral-> X-ray beam enters one side of the body and exit the other side

 Modifier usage

RT - RIGHT SIDE

LT - LEFTSIDE

50 - Bilateral

52 Modifier (Reduced Series)

Due to MD own decision procedure got reduced half then we have to add modifier (52)

Modifiers

26 -> professional component

 Interpretation and report of the radiological service is considered professional component.

TC -> Technical component

 The cost of the equipment.

 Supplies and resources such as room, electricity and salary of the radiology technician.
 Technician component is reported by the facility (or) office that owns the equipment.

Scenarios Radiology
1. X-ray of elbow (2 views)

2. X-ray of elbow (1 view)

3. X-ray elbow (5 views)

4. X-ray of ankle (LATERALS, TRANSVERSE VIEW)

1. Patient came to physician office for cough. MD ordered Chest X-ray one view. X-ray taken by using
own equipment after md interpreted the X-ray its showing no acute process. How will you report
provider service?

a. 71045-26 b. 71045-TC c. 71046 d. 71045

2. Patient came to hospital for cough. MD ordered Chest X-ray one view. X-ray taken by using hospital
equipment after md interpreted the X-ray it’s showing no acute process. How will you report hospital
service?

3. Patient came to hospital for cough. MD ordered Chest X-ray one view. X-ray taken by using hospital
equipment after md interpreted the X-ray it’s showing no acute process. How will you report PROVIDER
service?

CT -> Computed Tomography

MRI -> Magnetic Resonance Imaging

MRA -> Magnetic Resonance Angiography

Angio -> Blood vessels

3 types of blood vessels -> Arteries, veins, capillaries.

Coding points:

 Look for location

 How the procedure was performed
 With contrast
Without contrast
Without followed by with contrast. (Both he will do with & without contrast in same encounter)

(Contrast material is dye or chemical which is used to get clear visualization of the internal parts (or)
body area)

Contrast material administered routes

1. Oral –without contrast

2. Rectal - without contrast

3. Intravascularly (arteries &veins) – with contrast

4. Intra-articularly (Joints) – with contrast

5. Intrathecally (spine) – with contrast

1. CT of head without followed by with contrast?

2. CT of abdomen with oral contrast?
3. CT of brain without followed by with contrast?
4. MRI of brain without followed by with contrast?
5. MRI of breast without and with contrast unilateral?
 Bone & Joint studies (77071-77086)
DXA (or) DEXA (Dual energy x-ray absorptiometry)

 DXA used to perform to determine Bone (or) Joint abnormalities AND Bone age age, Bone
density

DXA

 This test helps to evaluate the risk of bone fractures which often are the result of osteoporosis
 DXA scans are coded Based on location of the body part being scanned.

1. DXA performed on a patient for body composition study?

a. 77080, 77081 b. 77080 c. 77086 d. 76499

2. A patient with osteoporosis reports to a physician office for a DXA bone density study of her spine to
monitor the severity of her condition what is the correct report for DXA section?
a. 77080 b. 77081 c. 77086 d. 77081-52

3. DXA scan for spinal fracture with assessment?

4. DXA scan for bone density study with vertebral fracture assessment?
Myocardial Perfusion Imaging Study

 To find the blood flow & pressure in heart muscle

 SPECT -> single-photon emission computerized tomography (SPECT)
 Tomographic,
 Attenuation correction

78451 -> myocardial perfusion imaging tomographic (SPECT) including attenuation correction,
qualitative wall motion, ejection fraction by first pass or gated technique additional quantification, when
performed; single study, at rest or stress (exercise or pharmacologic)

78452 -> multiple studies, at rest and/or stress (exercise or pharmacologic) and /or redistribution and/
or rest reinjection.

78453 -> myocardial perfusion imaging, planar (including qualitative or quantitative wall (motion,
ejection, fraction) by first pass or gated technique, additional quantification, when performed; single
study, at rest or stress (exercise or pharmacologic)

78454 -> multiple studies, at rest and/or stress (exercise or pharmacologic) and /or redistribution and/
or rest reinjection.

Cardiac blood pool imaging

1. Cardiac blood pool imaging first pass technique single study

2. Cardiac blood pool imaging first pass technique Multiple study
3. Cardiac blood pool imaging gated equilibrium single study
4. Cardiac blood pool imaging gated equilibrium Multiple study

Ultra Sound
 Using ultra sonic waves to visualize internal parts

Coding Points

 First we have to look for patient is (OB )pregnant) or Non - OB patient

 We have to look for limited ultra sound or complete ultra sound
 We have to look for location

(e.g)

76700 -> ultrasound, abdominal, real time with image.

Documentation: complete

(complete ultrasound examination code consist body parts like liver, gall bladder, common bile duct,
pancreas, spleen, kidneys and the upper abdominal aorta and inferior vena cava) Tot 8 parts

 If any one part missing means we have to go to limited code = 76705

Ultrasound for Retroperitoneal

 Complete US examination of the retro peritoneum (76770) consists of real time scans of the
kidneys, abdominal aorta, common iliac artery organs and inferior vena cava
 Alternatively clinical history suggests (urinary) tract pathology, complete evaluation of the
kidney and urinary bladder also comprises a complete retro peritoneum ultra sound.
 US transplanted kidney, real time and duplex Doppler with image documentation (76776)
 Without duplex Doppler (76775)

EXAMPLE:

1. US for transplanted kidney with Duplex Doppler documentation

2. US for transplanted kidney without Duplex Doppler documentation
3. US for Tran’s rectal, prostate volume study for brachy therapy treatment planning.
4. US guidance for fetal transfusion.
 Radiation Oncology

Treatment planning simulation

Simple 77261 Simple 77280 Delivery Delivery by SRS

Intermediate 77262 Intermediate 77285 S -> 77402 77371
Complex 77263 Complex 77290 I -> 77407 77372

C -> 77412 77373

Simple:

Planning requires a single treatment area of interest encompassed in a single part or simple parallel
opposed parts with simple or no blocking.

Intermediate:

Planning requires 3 or more covering parts, 2 separate treatment areas, multiple blocks or special
time dose constraints.

Complex

Planning requires high complex blocking custom shielding blocks, tangencies parts special wedges
or compensators three or more separate treatment areas rotational beam considerations, combination
of therapeutic modifiers.

 If physician tell all treatment simulation, delivery means we have to code all 3 codes( T, S, D)
 Simple: Single separate area treated
 Intermediate: Two separate area treated
 Complex: 3 or more separate area treated

Stereotactic body radiation therapy, treatment delivery for 4 fractions.

Radiation Treatment planning and simulation for 2 separate areas.

Brachytherapy

Clinical Brachytherapy requires the use of either natural or manmade radioelements applied into
or around a treatment field or interests.
Questions

1. Patient receives complex radiation treatment 2 times a day for 3 days code this service of clinical
management fractions?
a) 77427x3, 77431x3 b) 77427 c) 77525x3, 77523x3 d) 77427, 77431

1. A male patient being treated for prostate cancer brachy therapy treatment. 12 radio- active seeds
(or) interstitially applied with in the prostate what is the CPT code for the radiological component?
a) 0395T b) 77778 c) 77771 d) 77789